Centers for Medicare & Medicaid shifts from maintenance mode to modernization with SAFe

“SAFe provided a map that enabled us to shift to modernizing versus just maintaining the status quo. As a result, we will deliver value faster to hospitals, clinicians and medical facilities, resulting in better healthcare for our beneficiaries.”

—Brent Weaver, Director of Systems Implementation

We’ve come a long way from the idea that government’s entrenched operating models would not be able to adapt to the more fluid approach of Lean and Agile. While there’s still a mountain to climb for agencies striving to transform, many have adopted SAFe with notable success. As the initial implementations are beginning to mature, the first case studies are starting to come out of the gate.

We’re excited to share this story from Centers for Medicare & Medicaid Services (CMS). Not only have they proven that the ‘impossible’ is, in fact, possible, they’ve been exceptionally generous and candid with their journey. They share when and why they stumbled and how they ultimately got SAFe working within their complex environment that is heavily dependent on contractors and at the mercy of ever-changing budgets and legislation. Their section “8 Tips for a Successful Government SAFe Transformation” alone is worth its weight in gold.

Prior to adopting SAFe, a few isolated programs at CMS had started using Scrum, but given the size and complexity of programs, Scrum did not lend itself well to longer-range planning and the identification and mitigation of dependencies among the teams. Plus, the organization had cultural battles to overcome.

CMS turned to SAFe for a much-needed approach to scaling Agile and systems thinking that was critical to an organization of this size and complexity.

CMS’s Hospital Quality Reporting (HQR) system, which healthcare facilities use to report data to CMS, forged the path with SAFe. To meet tight timeframes, CMS initially decided to shortcut the recommendations from the SAFe Implementation Roadmap and skip SAFe training—a decision that created significant challenges and that, in hindsight, they wouldn’t recommend to other organizations.

After the first PI, CMS began adhering to the Roadmap, and found value in identifying Value Streams and ARTs.

Along the way, they had to overcome a few challenges, including integrating contractors and fostering a culture for transformation. For the former, CMS delivered Leading SAFe® and role-based training to many contractors. And as an unexpected benefit, SAFe helped unify CMS team members and contractors, as well as unify contractors from various companies.

It took time for both internal and external stakeholders to feel comfortable about the transformation, but with results, they have embraced it.

The results of their efforts are clear:

Budget shift to modernization versus maintenance – Instead of 100 percent of the budget going to maintain the existing HQR system, now only 40 percent is dedicated to it. A full 60 percent of the budget goes toward innovation for the system, helping the agency deliver on citizen expectations.

Higher quality – The HQR group reports a 55% decrease in help desk tickets from hospitals—demonstrating a direct impact on customer satisfaction.

Happier people – Surveys conducted before and after SAFe show a 27% increase in employee satisfaction.

While CMS has to yet measure customer satisfaction gains directly, they know that fewer quality issues and more innovation contribute to that goal.

Ultimately, SAFe provided a map that enabled CMS to shift from maintaining the status quo to modernizing the organization.

We at Scaled Agile are honored to be a part of the CMS transformation. Their mission to care for the health and well being of American citizens motivates us to do all we can to help them succeed. The agency has come a long way since the difficult days of the Healthcare.gov launch. The hard work of these dedicated civil servants and their industry partners stands as a shining example and beacon of hope for other government programs seeking to achieve agency agility.

Special thanks to those who helped create the CMS case study, including Brent Weaver, Director of Systems Implementation at CMS; Debra Santos, Director of Hospitals, ASC, and QIO Systems; and Ernie Ramirez, President of Agile Six Applications.